We have always worked hard to provide our members with access to quality, affordable health care. In fact, it's our corporate mission. Many of our pre-reform business practices were already in accordance with provisions of the Patient Protection and Affordable Care Act.
|Reform:||Our Current Practice:|
|Requires health plans to spend a minimum of 80 to 85 percent of premium dollars on medical claims (depending on the type of coverage)||
Where Does Your Blue Cross Premium Dollar Go?
Graphic showing a breakdown of where you dollar is spent.
* Physician services include doctor visits and services, imaging and outpatient services not performed in a hospital.
Source: Louisiana Health Service & Indemnity Co. and HMO Louisiana, Inc. 2012 financials
|Provides "first-dollar" coverage for preventive services and encourages prevention and primary care||Most of our current plans already include first-dollar coverage for routine wellness benefits, meaning your deductible does not apply to these services. We also provide health and wellness tips and education through our newsletters and website to help members get and stay healthy.|
|Reduces avoidable hospital readmissions||Our Care Management team of nurses, doctors and pharmacists helps patients with serious and/or chronic conditions get the most from their health care benefits.
We believe that educating patients supports better results and lower costs for our members. Our nurses work with patients and their doctors to coordinate care. This personal guidance:
|Requires effective appeals process||We have a clear process in place for submitting complaints and appeals. We provide information about this process in writing to all members. Our Customer Service Department also can help members through the process.|
|Works to eliminate fraud and waste||We have an award-winning Financial Investigations Unit that protects our members' interests by identifying and deterring fraud, waste and abuse in the system. This unit saves our members millions of dollars each year and works with law enforcement when appropriate to prosecute fraud cases.|
This information has been compiled from a variety of sources. Please note that interpretations may vary, and you should consult your attorney and/or tax advisor for more specific information. New and existing state laws may impact many of these provisions as well as future federal and state regulations. Please also note that the new law allows for "grandfathering" of certain health plans, making those plans not necessarily subject to portions of the new law.
Contact an authorized
agent for expert advice.